Bridging intestinal failure with Teduglutide – A case report

Abstract

Introduction and importance Intestinal failure (IF) describes the state of a person's gastrointestinal absorption capabilities becoming unable to absorb fluids and nutrients needed to sustain normal physiology, leading to severe comorbidities and if left untreated, to death. IF is most commonly seen as a result of short bowel syndrome (SBS). Teduglutide is a glucagon-like peptide 2 (GLP-2) analogue used in the treatment of patients with SBS and intestinal failure (IF) as a way to reduce the need for parenteral support. Teduglutide leads to the growth of intestinal mucosa by stimulating intestinal crypt cell growth and inhibiting enterocyte apoptosis. It is usually prescribed as a final treatment step after the diagnosis of SBS-IF is made. Case presentation In this case report we present a novel strategy for using teduglutide as a bridging therapy to intestinal reconstruction. The patient achieved enteral autonomy preoperatively, underwent surgery, and remained in enteral autonomy after intestinal reconstruction. Clinical discussion Teduglutide has been previously exclusively used as continuous therapy in SBS-IF, this is the first reported case of using teduglutide as bridging to intestinal reconstruction. The hypothesis of this approach was to achieve an adequate nutritional status for reconstruction without the disadvantages of parenteral support. Conclusion The controlled application of teduglutide can provide the benefits of preoperative nutritional optimization without the disadvantages of parenteral support and at the same time facilitate an earlier and easier intestinal reconstruction.

Teduglutide for the treatment of low-output enterocutaneous fistula – A pilot randomized controlled study

“…It is not clear if the fistula resolution was due to the mechanism of teduglutide or by a general improvement of the patient's nutritional status, as the authors note that "her visceral protein stores returned to within normal limits during this period." Schlager et al also reported the off-label use of teduglutide as a "bridging therapy" to intestinal reconstruction for a 37 year-old man with Crohn's Disease and two small intestinal enterocutaneous fistulas [24]. In this case, however, the fistula did not close by the time the patient was nutritionally optimized for intestinal reconstruction four months after teduglutide initiation.…”